Subject Initials
Item
Subject Initials
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Are you willing to tell us how you learned about this study?
Item
Are you willing to tell us how you learned about this study?
boolean
C0242800 (UMLS CUI [1])
Item
If yes, how did the subject initially hear about the study or how was the subject recruited into the study?
text
C0683836 (UMLS CUI [1])
Code List
If yes, how did the subject initially hear about the study or how was the subject recruited into the study?
CL Item
Prior Clinical Patient (1)
CL Item
Physician or Colleague Referral (2)
CL Item
Word of mouth (3)
CL Item
Posters, Flyers or Brochures (4)
CL Item
Community Outreach (5)
CL Item
Internet/Website/Email (6)
CL Item
Local Advertising (PLACED BY SITE) (7)
CL Item
Central/National Media Campaign (PLACED BY GSK) (8)
CL Item
Call Centre (Organized by GSK) (9)
Item
If Prior Clinic Patient, please specify
integer
C0585862 (UMLS CUI [1,1])
C0332152 (UMLS CUI [1,2])
C2347804 (UMLS CUI [1,3])
Code List
If Prior Clinic Patient, please specify
CL Item
Chart review, mailed a letter/postcard to potential subjects (101)
CL Item
Chart review, contacted potential subjects by phone (102)
CL Item
Introduced study during office visit for other medical reason (104)
CL Item
Subject from feeder study into long-term extension study (105)
CL Item
Introduced study during office visit for [insert study specific ailment] (103)
CL Item
Other physician or colleague referral (not listed above) (199)
Prior Clinic Patient (Study specific ailment)
Item
If introduced during study visit for study specific ailment, please insert study specific ailment.
text
C0585862 (UMLS CUI [1,1])
C0332152 (UMLS CUI [1,2])
C2347804 (UMLS CUI [1,3])
C0012634 (UMLS CUI [2,1])
C2348235 (UMLS CUI [2,2])
C0008976 (UMLS CUI [2,3])
Other Prior Clinic Patient
Item
If Other prior clinic patient (not listed above), please specify
text
C0585862 (UMLS CUI [1,1])
C0332152 (UMLS CUI [1,2])
C2347804 (UMLS CUI [1,3])
C0205394 (UMLS CUI [1,4])
Item
If Physician or Colleague Referral, please specify
integer
C0583834 (UMLS CUI [1])
Code List
If Physician or Colleague Referral, please specify
CL Item
Mailed letters to referring physicians about study (201)
CL Item
Calls to referring physicians about study (202)
CL Item
Presentations about study to referring physicians (203)
CL Item
Other physician or colleague referral activity (not listed above) (299)
Other Physician or Colleague Referral
Item
If Other physician or colleague referral activity (not listed above), please specify
text
C0583834 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Item
If Word of Mouth, please specify
integer
C0034866 (UMLS CUI [1,1])
C1705847 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,3])
Code List
If Word of Mouth, please specify
CL Item
subject heard about study from current/past study participant (301)
CL Item
subject heard about study from friend or family member (302)
CL Item
subject heard about study from disease or support group (303)
CL Item
Other word of mouth method (not listed above) (399)
Other Word of mouth
Item
If Other word of mouth method (not listed above), please specify
text
C0034866 (UMLS CUI [1,1])
C1705847 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,3])
C0205394 (UMLS CUI [1,4])
Item
If Posters, Flyers or Brochures, please specify
integer
C0030258 (UMLS CUI [1,1])
C0949214 (UMLS CUI [1,2])
C0376675 (UMLS CUI [2,1])
C0949214 (UMLS CUI [2,2])
Code List
If Posters, Flyers or Brochures, please specify
CL Item
Displayed in our clinic (401)
CL Item
Information at day care (402)
CL Item
University/school posting (403)
CL Item
Church posting (404)
CL Item
Other poster, flyer, brochure display (not listed above) (499)
Other Posters, Flyers or Brochures
Item
If Other poster, flyer, brochure display (not listed above), please specify
text
C0030258 (UMLS CUI [1,1])
C0949214 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C0376675 (UMLS CUI [2,1])
C0949214 (UMLS CUI [2,2])
C0205394 (UMLS CUI [2,3])
Item
If Community Outreach, please specify
integer
C0033414 (UMLS CUI [1,1])
C0008976 (UMLS CUI [1,2])
C0009462 (UMLS CUI [1,3])
C2347796 (UMLS CUI [1,4])
Code List
If Community Outreach, please specify
CL Item
Screening day/event (501)
CL Item
Health fair (502)
CL Item
Pharmacy programme (503)
CL Item
Other community outreach method (not listed above) (599)
Other Community Outreach
Item
If Other community outreach method (not listed above), please specify
text
C0033414 (UMLS CUI [1,1])
C0008976 (UMLS CUI [1,2])
C0009462 (UMLS CUI [1,3])
C2347796 (UMLS CUI [1,4])
C0205394 (UMLS CUI [1,5])
Item
If Internet/Website/Email please specify
integer
C0282111 (UMLS CUI [1,1])
C0949214 (UMLS CUI [1,2])
C2349146 (UMLS CUI [2,1])
C0949214 (UMLS CUI [2,2])
C0013849 (UMLS CUI [3,1])
C0949214 (UMLS CUI [3,2])
Code List
If Internet/Website/Email please specify
CL Item
Veritas Medicine (602)
CL Item
Harris Interactive (603)
CL Item
www.emergingmed.com (604)
CL Item
www.clinicaltrials.gov (605)
CL Item
www.centrewatch.com (606)
CL Item
Study specific website (ex:www.OApainstudy.com) (607)
CL Item
Other internet/email method (not listed above) (699)
Other Internet/Website/Email
Item
If Other internet/email method (not listed above), please specify
text
C0282111 (UMLS CUI [1,1])
C0949214 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2349146 (UMLS CUI [2,1])
C0949214 (UMLS CUI [2,2])
C0205394 (UMLS CUI [2,3])
C0013849 (UMLS CUI [3,1])
C0949214 (UMLS CUI [3,2])
C0205394 (UMLS CUI [3,3])
Item
If Local Advertising please specify
integer
C0205276 (UMLS CUI [1,1])
C0679720 (UMLS CUI [1,2])
C0949214 (UMLS CUI [1,3])
Code List
If Local Advertising please specify
CL Item
Local newspaper advertisement (701)
CL Item
Local radio advertisement (702)
CL Item
Local television advertisement (703)
CL Item
Local direct mail campaign (704)
CL Item
Other local advertising (not listed above) (799)
Other Local Advertising
Item
If Other local advertising (not listed above), please specify
text
C0205276 (UMLS CUI [1,1])
C0679720 (UMLS CUI [1,2])
C0949214 (UMLS CUI [1,3])
C0205394 (UMLS CUI [1,4])
Item
If Central/National Media Campaign please specify
integer
C0679720 (UMLS CUI [1,1])
C0681788 (UMLS CUI [1,2])
Code List
If Central/National Media Campaign please specify
CL Item
National newspaper advertisement (801)
CL Item
National radio advertisement (802)
CL Item
National television advertisement (803)
CL Item
National magazine campaign (804)
CL Item
National coupon advertisement (805)
CL Item
National direct mail campaign (806)
CL Item
Other national campaign (not listed above) (899)
Other Central/National Media Campaign
Item
If Other national campaign (not listed above), please specify
text
C0679720 (UMLS CUI [1,1])
C0681788 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Other source of information
Item
If Other source of information, please specify
text
C0683836 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])